AP_CLM_PX_EXH_ACCUM_GRPS

Description:

The AP_CLM_PX_EXH_ACCUM_GRPS table contains the accumulation groups, such as deductibles, out-of-pocket maximums, and service limits, that were already at their limit when a service on an AP claim was evaluated against them. Each row is one service line paired with one accumulation group that held it back, along with the date and time the service was evaluated. Because the group had no remaining room, the service did not accumulate toward it, so these rows have no matching rows in the accumulation tables. Retroadjudication uses this information to find and reprocess services that might pay differently once an earlier claim frees room in the group. Rows are rewritten each time the claim is readjudicated, so they describe the most recent adjudication rather than a history.

Primary Key

Column Name	Ordinal Position
TX_ID	1
LINE	2

Column Information

	Name	Type	Discontinued?
1	TX_ID	NUMERIC	No
	The unique identifier (.1 item) for the transaction record.
2	LINE	INTEGER	No
	The line number for the information associated with this record. Multiple pieces of information can be associated with this record.
3	EXHAUSTED_ACCUM_GRP_ID	NUMERIC	No
	Accumulation group that was already at its limit when this service was evaluated against it, so nothing accumulated to it.
4	EXHAUSTED_INSTANT_UTC_DTTM	DATETIME (UTC)	No
	Instant at which this service was evaluated against the accumulation group on this line.